Pregnancy in people who have survived Ebola virus disease
Authors: Ibrahima Socé Fall, Awa Ndir
Journal: The Lancet Global Health (2023)

Pregnancy in people with or who have survived Ebola virus disease has been historically perceived as potentially life-threatening for the pregnant parent, their infant, and the health-care providers treating them. Although published studies have mainly focused on the risks related to pregnancy in mothers with active Ebola virus disease, little is known about the real risk of pregnancy in people who have recovered from this disease. The cohort study reported by Mosoka P Fallah and colleagues in The Lancet Global Health expands the current knowledge on pregnancy-related outcomes after recovery from Ebola virus disease, and its potential effects on infant growth and development.1Fallah MP Reilly C Van Ryn C et al.Pregnancy, pregnancy outcomes, and infant growth and development after recovery from Ebola virus disease in Liberia: an observational cohort study.Lancet Glob Heath. 2023; 11: e1053-e1060Summary Full Text Full Text PDF Google Scholar Its results reveal a low risk of Ebola virus disease reactivation or transmission in surviving mothers, potential protection against Ebola virus disease with the presence of anti-Ebola antibodies in neonates, and no significant effects on infant growth and development. These findings led the authors to conclude that safe pregnancies are entirely possible after recovery from Ebola virus disease. However, this conclusion should be interpreted with caution. First, as rightly highlighted by the authors, conception occurred a median of 14 months (IQR 10–20) after symptom onset in participants in their sample, which might explain the low risks related to pregnancies reported in this study compared with the worse adverse outcomes reported in studies in which conception occurred shortly after recovery (eg, between 5 and 8 months2Godwin CL Wohl DA Fischer Nd WA et al.Reproductive health sequelae among women who survived Ebola virus disease in Liberia.Int J Gynaecol Obstet. 2019; 146: 212-217Crossref Scopus (5) Google Scholar). Second, the monitoring that the survivors of Ebola virus disease (the seropositive group) benefitted from in this observational study (eg, antenatal care, transportation to a health-care facility) might have biased the adverse pregnancy outcomes reported; no information related to antenatal care access and delivery conditions were collected for the comparison group (the seronegative group). Third, a larger cohort of infants born to individuals who have recovered from Ebola virus disease, and a longer follow-up period, are necessary to better assess the effects on infant growth and development. Finally, the use of other assessment criteria more specific to growth and neurological development would enable a more robust assessment. A robust systematic review published in 2020 on pregnancy and the implications of breastfeeding in the context of Ebola virus disease, which also included data on the 2018 outbreak in DR Congo, showed that the virus could remain detectable in pregnancy-related fluids and in breastmilk after recovery. The presence of Ebola virus RNA in two of the 354 breastmilk samples in this study, taken 3 days after birth, suggest that there is a risk, albeit a low risk, of transmission from breastmilk for a longer time after recovery than the previous systematic review suggested (the time from Ebola virus disease symptom onset to birth in these two samples was 15 months and 16 months).3Foeller ME Carvalho Ribeiro do Valle C Foeller TM Oladapo OT Roos E Thorson AE Pregnancy and breastfeeding in the context of Ebola: a systematic review.Lancet Infect Dis. 2020; 20: e149-e158Summary Full Text Full Text PDF PubMed Scopus (23) Google Scholar Subsequently, WHO guidelines on the management of pregnancy and breastfeeding in the context of Ebola virus disease recommend that women who have recovered from the disease attend frequent antenatal care and get inpatient care at a facility starting at 36 weeks of pregnancy.4WHOGuidelines for the management of pregnant and breastfeeding women in the context of Ebola virus. disease.https://www.who.int/publications/i/item/9789240001381Date accessed: June 1, 2023Google Scholar Access to health-care facilities should enable testing of breastmilk and provision of appropriate milk substitutes as recommended.5The LancetAppropriate care for pregnant women in Ebola outbreaks.Lancet. 2020; 395: 468Google Scholar The absence of transmission of Ebola virus disease to caregivers in this study should not imply an absence of risk to health-care workers providing care to pregnant survivors. Appropriate infection prevention and control measures should be applied during antenatal care and delivery after assessment of potential risks.6WHOStrengthening infection prevention and control in primary care. Sept 17, 2021. Strengthening infection prevention and control in primary care.https://www.who.int/publications/i/item/9789240035249Date accessed: June 1, 2023Google Scholar Standard precautions should be applied at all times and for all patients irrespective of their Ebola virus disease status (ie, seropositive or seronegative). Respect of adequate measures will prevent transmission of any pathogens to the newborn baby and the caregivers, and protect the birthing parent from any potential infection. Since the 2014–16 Ebola virus disease outbreak in west Africa, remarkable progress has been made in therapeutics, especially for pregnant individuals who were previously denied access to pharmaceuticals due to the scarce information on drug safety and the potential effects on the fetus. Given the increased knowledge on this issue following the Ebola virus disease outbreaks reported subsequently, it would be interesting for future research to explore the effects of therapeutics on pregnancy outcomes after recovery from Ebola virus disease. The findings of this study certainly contribute to rebuilding the perception around safe pregnancies and reducing the stigmatisation of people who have recovered from Ebola virus disease. Such results should be considered when developing risk communication and community engagement interventions in potential future Ebola virus disease outbreaks. A socioanthropology study would help to better understand the factors associated with the perception of pregnancy risks related to Ebola virus disease, document lessons learned from past outbreaks, and find innovative ways, in collaboration with communities, to improve pregnancy outcomes and the perception of people who have survived Ebola virus disease. We declare no competing interests. Pregnancy, pregnancy outcomes, and infant growth and development after recovery from Ebola virus disease in Liberia: an observational cohort studyThe risks of Ebola virus reactivation in the peripartum and postpartum period and of adverse birth outcomes are low in those who have recovered from Ebola virus disease and become pregnant approximately 1 year after acute Ebola virus disease. The implication for clinical practice is that care of people who are pregnant and who have recovered from Ebola can be offered without risks to health-care providers or stigmatisation of the mothers and their offspring. The implication for prospective mothers is that safe pregnancies are entirely possible after recovery from Ebola. Full-Text PDF Open Access